Reaching Remote Health Workers in Malawi: Baseline Assessment of a Pilot mHealth Intervention

Abstract

mHealth has great potential to change the landscape of health service delivery in less developed countries—expanding the reach of health information to frontline health workers in remote areas. Formative, process, and summative evaluation each play an important role in mHealth interventions. K4Health conducted a Health Information Needs Assessment in Malawi from July to September 2009 (formative evaluation) that found widespread use of cell phones among health workers offering new opportunities for knowledge exchange, especially in areas where access to health information is limited. K4Health subsequently designed an 18-month demonstration project (January 2010 to June 2011) to improve the exchange and use of family planning/reproductive health and HIV/AIDS knowledge among health workers, which included the introduction of a short message service (SMS) network. K4Health conducted a pretest of the mHealth intervention from June to October 2010. A baseline assessment was carried out in November 2010 before expanding the SMS network and included use of qualitative and quantitative measures and comparison groups (summative evaluation). Routinely collected statistics also guide the program (process evaluation). This article describes the approach and main findings of the SMS baseline study and contributes to a growing body of evidence measuring the effectiveness and efficiency of mHealth programs using a strong evaluation design.

Acknowledgments

The authors thank the participants in the K4Health/Malawi SMS network whose opinions and feedback formed the basis for this paper. Thanks also to the K4Health/Baltimore and MSH/Malawi project teams for their collaboration on the mHealth baseline study. Full support for this study was provided by the K4Health project, Leader with Associate Cooperative Agreement No. GPO-A-00-08-00006-00. The views expressed in this publication do not necessarily reflect those of MSH or the K4Health project.

Notes

¹A minimum sample size of 95 is needed in order to calculate a mean and confidence interval for each indicator.

²During the baseline phase, the project distributed Java-enabled phones to the pretest group of CHWs, whereas in subsequent phases, the project distributed cell phones with basic voice and text capability.

³For the end line study, this indicator was improved by separating it into two indicators: timely report rate (average time required for CHWs to report important events [stockouts, transportation breakdowns]) and timely feedback rate (average time required for CHWs to receive feedback on important questions [e.g., specific medical conditions, effects of contraceptive uses, dosage amounts]) from district program coordinators.

⁴Here, cost is a function of the fee charged for sending and receiving a text message. It does not take into account CHW salary costs.

⁵Here, cost is a function of the transportation used to travel to and from the health center or district level and does not take into account CHW salary costs. The most common transportation means include bicycle (their own or hiring one) public transport and walking.